Organization
UPPER LAKES DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN GONZALEZ D.D.S. (OWNER)
(920) 582-0688
Entity
Organization
Contact information
Practice address
908 E MAIN ST STE C, WINNECONNE, WI 54986-9672
(920) 582-0688
Mailing address
PO BOX 369, WINNECONNE, WI 54986-0369
(920) 582-0688
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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